Provider Demographics
NPI:1497731715
Name:RODGERS, GAIL MARIAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:MARIAN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:MARIAN
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:495 STATE ST STE 520
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:503-365-8111
Mailing Address - Fax:503-365-0582
Practice Address - Street 1:495 STATE ST
Practice Address - Street 2:SUITE 340
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-365-8111
Practice Address - Fax:503-365-0582
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional